Adherence to guidelines for continuous morphine sulfate infusions

A retrospective chart audit evaluating the degree of adherence of health-care personnel to guidelines for continuous intravenous infusion of morphine sulfate was conducted. The audit was conducted one year after implementation of guidelines for administering morphine sulfate by continuous i.v. infusion. Audit criteria were developed from these guidelines and used to evaluate justification of use, adherence of physicians, pharmacists, and nurses to procedures, and patient outcome. Audits were completed for 11 of 13 patients who received morphine sulfate infusions during the one-year study period. All patients met the standard for justification of use. Adequate patient outcome, defined as chart-documented pain relief within 24 hours, was achieved in six patients. The median time to pain control was 20 hours (range 4-168 hours). Physicians' and pharmacists' adherence to the guidelines was acceptable in over 80% of patients, but documentation of hourly monitoring of blood pressure and respiratory rate and rhythm by nurses met the standard in only 55% of patients; this may have been related to lack of a designated place in the chart for recording this information. The morphine sulfate infusion guidelines appear to contribute to safe and effective therapy.